Chan, K. E.; Pathak, S.; Smart, N. J.; Batchelor, N.; Daniels, I. R..
Colorectal Disease, June 2016, Vol. 18 Issue: Number 6 p578-585, 8p;
Advanced age and occult cardiorespiratory disease are associated with
increased morbidity and mortality following surgery. Cardiopulmonary
exercise testing (CPET) may allow the identification of high‐risk
patients and facilitate planned postoperative critical care support.
The aim of this study was to determine whether preoperative CPETin
patients aged over 80 undergoing elective colorectal cancer resection
was associated with improved outcome. All patients aged 80 years and
above undergoing elective colorectal cancer resection between 1 March
2011 and 1 September 2013 were retrospectively analysed. Referral for
CPET testing was at the discretion of the operating surgeon.
Postoperative critical care unit (CCU) admission was based upon the
CPETresults. Ninety‐four patients were identified, of whom 48 underwent
CPETtesting. The CPET group were significantly older than the
non‐CPETgroup (85 vs83 years, P= 0.04) and were more likely to have a
planned admission to CCU postoperatively (P< 0.0001). Despite the
increased use of CCU resources, the overall CCU length of stay (LOS) in
the CPET group did not differ from the non‐CPETgroup, but the
non‐CPET group had a higher proportion of Level‐3 care. There were no
differences in the incidence of unplanned CCU admission between the
CPET and the non‐CPETgroup (P= 0.23). There were no differences in
overall LOS between the two groups (P= 0.42). There was no difference in
mortality (P= 0.11), overall complications (P= 0.53) or severe
complications (P= 0.3). Preoperative CPET testing in patients aged over
80 undergoing elective colorectal cancer resection allows
identification of higher‐risk patients and mitigation of risk by
preemptive admission to a CCU. This stratification allows equivalent
results to be achieved in high‐ and low‐risk elderly patients
undergoing colorectal surgery.